TTCF Texas Trauma Designation Education Course 2012

1. Registration

The Texas Trauma Designation Education Course (TTDEC) is
provided and hosted by the Texas Trauma Coordinator's Forum.
Scheduled for May 7, 2012 at The Embassy Suites in Austin, this course will be of interest to hospital administrators,
nurses, trauma program managers, trauma registrars and other
personnel working in the field of trauma care.

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* 1. Registration fees should be mailed to: Texas Trauma Coordinator's Forum, P. O. Box 177, Wichita Fall, Tx 76307.

$150.00 TTCF Non-Member

$100.00 TTCF Member (To qualify for the discount rate you must be a current member of TTCF)

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* 2. Last Name

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* 3. First Name

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* 4. Agency/Organization

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* 5. Title/Position

Trauma Coordinator/Program Manager

Trauma Registrar

Trauma Medical Director

Hospital Administrator

Other

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* 6. Trauma Center Level

Level 1

Level 2

Level 3

Level 4

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* 7. Years in current position:

1-2

3-5

5-10

10-15

>15

TTCF Texas Trauma Designation Education Course 2012

1. Registration

Question Title

* 1. Registration fees should be mailed to: Texas Trauma Coordinator's Forum, P. O. Box 177, Wichita Fall, Tx 76307.

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* 2. Last Name

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* 3. First Name

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* 4. Agency/Organization

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* 5. Title/Position

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* 6. Trauma Center Level

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* 7. Years in current position:

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* 8. Address: (mailing, city, state, zip)

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* 9. E-Mail

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* 10. Work Number

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* 11. Cell Phone Number